MEDICARE: JASON PRICE OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	1936	NC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	P00791294	OTHER	NC	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	093P9	OTHER	NC	BLUE CROSS BS

General Provider Information

NPI Number	:	1821081282
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JASON PRICE OD

Provider Business Mailing Address
First Line	:	1950 OLD GALLOWS RD STE 520
Second Line	:
City	:	VIENNA
State	:	VA
Zip	:	22182-3970
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	110 CAPCOM AVE STE 100
Second Line	:
City	:	WAKE FOREST
State	:	NC
Zip	:	27587-6531
Country	:	US
Telephone Number	:	919-556-1909
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/31/2005
Last Update Date	:	02/25/2022

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Directions to “ JASON PRICE OD” Practice Location

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